The patients slowed to a trickle, and the doctor’s income was cut by 25 percent.

Still, Dr. Paul Cary, a Dallas internist, does not regret changing his traditional primary care practice three years ago into a concierge model, which charges patients an annual fee.

“The overall picture hasn’t changed in terms of the doctor and patient satisfaction,” he said. “I get more time with my patients, and everybody is happy.”

Cary whittled his 2,500 patients to about 400 by joining MDVIP, a national network of concierge doctors. The company is owned by Procter & Gamble and based in Boca Raton, Fla.

Most of his patients left rather than pay Cary an annual fee. Some signed on with the other doctors in his group, although a second physician recently joined MDVIP, causing further patient shuffling.

In the Dallas area, MDVIP’s annual fees range from $1,500 to $1,650 for patients of the 17 doctors enrolled so far. And the network is likely to grow.

“I don’t think we’re anywhere near the saturation level in any market,” said Dan Hecht, the company’s chief executive officer. “The more we do, the more interest there is from patients.”

Patients lose doctors

For more than a decade, concierge medicine has been an attractive alternative for primary care doctors, who tend to receive the lowest compensation of all physicians.

“It’s all about the quality of the work life,” said Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School. “Primary care doctors are asked to do many things, work long hours.

“Often, they’re in practices that don’t work very well, with lots of paperwork, being on call and needing prior approval by insurance companies.”

“Concierge care is a rational response to a system that’s not working well, by creating additional pay,” Phillips said. “But 1,700 patients lose their doctor everytime one of them joins MDVIP in the Boston area. It’s a threat to our health.”

Doctors receive an annual fee of about $1,100 per patient from MDVIP, which promises an annual infusion of about $660,000 into any practice that reaches the optimal size of 600 patients.

But Hecht noted that every MDVIP doctor runs his or her own practice and pays overhead costs and staff salaries from the patient fees and any other insurance billing. The doctor gets only what’s left from that.

Hecht rejected the idea that doctors are opting for these smaller practices simply to raise their incomes.

“It is not about the money,” he insisted. “We do hope they’re making the same or even better. They do it because they want to deliver great patient care and they are frustrated.”

Transition help

MDVIP’s share of the patient fees covers the transition cost of turning a regular physician practice into a concierge model. The company stations an employee in the doctor’s office to explain the change, which takes about four months to accomplish.

Patients are told the benefit of staying with their doctor’s practice, which includes easier access and a complex annual physical not typically covered by insurance.

“If you’re on Medicaid, the average person probably can’t afford it,” Hecht said. “But average to upper incomes certainly can. It’s more of that priority choice. If people can afford to smoke, they can afford MDVIP.”

Nearly 700 doctors have been recruited to join the company’s national concierge network since the company formed in 2000.

“We reach out to doctors who we think will be right for our model,” Hecht said, describing the process as a courtship of phone calls and office visits by company representatives. Sometimes an MDVIP doctor will help in the bidding.

Getting into the network involves a detailed analysis of the physician’s practice, including patient demographics such as ZIP codes in affluent and middle-class areas.

Patients also are contacted to determine their loyalty to the doctor, which translates into their likelihood to stay with the practice.

“We turn away nine out of 10 doctors,” Hecht said of the analysis, which concludes with a fairly reliable income estimate for the doctor.

“The doctor starts on day one with a successful practice,” he said of going into concierge medicine.

While Cary, the Dallas doctor, lost income when he made the change, it has been a good transition, he said.

Fewer patients and a shorter workday have persuaded him to continue working even though he has turned 65.

“I enjoy what I’m doing,” Cary said. “This practice has become so much more enjoyable that I will continue doing it.”

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